Howard Koh spent two decades as a doctor. Working one-on-one with patients is “a noble and almost sacred experience,” he told scores of HMS students in the School’s packed Tosteson Medical Education Center amphitheater on October 27, in a lecture titled “Health Policy, Health Service and Leadership in the Era of Health Reform.”
But working in public health is just as important, Koh said.
The assistant secretary for health for the U.S. Department of Health and Human Services (HHS) and former director of the Division of Public Health Practice at the Harvard School of Public Health told how his experience working with patients pushed him toward the public health arena.
“When your patients are suffering and dying preventable deaths, you ask yourself, ‘Can we do this in some other way?’” he said.
Koh, who also served for six years as the Massachusetts commissioner of public health, joined HHS in 2009.
Working in Washington is “sometimes frustrating but absolutely fascinating,” Koh said. “This is a job that has pushed me and all of my colleagues to the absolute limit and beyond. But the bottom line is, it’s the job of my life.” He added, “If you ever have the chance to serve your state or your country in a role like this, do not hesitate.”
Koh acknowledged the “incredible challenges” in public health: big killers like cancer and cardiovascular disease, tobacco and substance abuse, infectious disease epidemics, vaccine-preventable illnesses that still kill people, chronic conditions like overweight and obesity, health disparities and a fragmented, costly health care system.
“Many people would hear this list and get pretty overwhelmed,” Koh said. But working in public health is all about “stepping forward and saying, ‘We can do something about this.’”
Koh noted that many of the factors that impact health—such as poverty, discrimination, lack of access to insurance and health care, and language barriers—have nothing to do with biology or disease.
When Koh was the public health commissioner for Massachusetts, he focused on cancer prevention and tobacco control. Critics told him preventing cancer would be too hard, but he took it as a challenge. He was overjoyed when, in 2004, the state passed its smoke-free workplace law.
At HHS, Koh is helping implement preventive, public health-oriented aspects of the health reform law signed last spring by President Obama.
For instance, the law requires insurance companies to provide high-value prevention services, including cancer screening, obesity screening and tobacco cessation programs, at no additional cost to the insured. Other measures include encouraging businesses to create healthy workplaces, reducing the number of hospital-acquired infections and hospital readmissions, and adding graphic warning labels on cigarette packs. “We want each of the 15 billion packs of cigarettes sold each year in this country to become mini-billboards for prevention,” said Koh. (Note: On November 7, 2011, a federal judge in Washington, D.C. blocked the rule requiring the graphic warning labels on cigarette packs by September 2012.)
“None of this is easy,” Koh admitted. “If you do this work you have to be ready for tremendous ups and downs.”
But, he added, “We are looking to you—the future leaders of this country—to make a difference.”
